Cohen said that initially it was “jolting” to hear the request; his first instinct as a doctor and psychiatrist was to think about possible problems, like depression. He made it clear he could not fulfill her request. But he thinks policy should change to take into account the thoughtful, considered decisions of those who wish to control the end of their life.
“I have, like most physicians, a bias to reflexively begin to think this is suicidal behavior on their part,” he said. “What I have begun to develop is in fact an appreciation that there are a lot of people out there that if you put yourselves in their shoes, it actually does make sense what they’re saying and it’s high time we dropped our biases and prejudices and listened to what they had to say.”
Nate Lamkin, a social worker at Hospice of the North Shore & Greater Boston, said he opposes the initiative because access to palliative care and hospice are not widespread enough and it would be premature to offer patients medication that could end their lives before improving other services.
“It’s not uncommon for any of us on the team to hear people expressing a wish to die, and our nurses regularly get asked by people who are just getting started with us and in a lot of pain,” he said. “The vast majority of the time, when someone’s symptoms are brought under control, they withdraw that request. . . . Even patients who are terminally ill and facing their own death within the next weeks or months, if they’re physically comfortable they can have a lot of meaningful time with loved ones.”
It is also unclear how doctors, hospitals and hospices will respond should the initiative pass. Dr. Britain Nicholson, chief medical officer at Massachusetts General Hospital, said that last month nurses, physicians, and others at Partners HealthCare began meeting to examine basic questions about the initiative so they would be prepared should it pass. For example, he said, what programs might they need to put in place to refer patients if physicians do not want to offer the prescription?
Statistics kept in Oregon and Washington show that very few people go through the process to get a prescription. Many people who receive the prescriptions never take the drugs, dying naturally of their underlying disease. Oregon is now known for having excellent end-of-life care, in addition to the option for physicians to prescribe drugs to end life.
Dr. Susan Tolle, a physician at Oregon Health & Science University, said that although she has not taken a stand on whether having the option is good or bad, many assume too quickly that what happened in Oregon — improvements in end-of-life care — will simply take place if similar initiatives are passed in other states.
“We chose to take this opportunity to push harder, to improve end-of-life care,” Tolle said. “That does not mean that will automatically happen in Massachusetts.”